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In vitro studies of te novel protein Q7: role on hyaluronian regulation in breast tumor microenvironment
Get PDFCancer is a group of multifactorial diseases, which involves variations in multiple genes, often coupled with environmental causes. It is characterized by uncontrolled growth of cells that are able to divide continually and invade into surrounding tissues. In Italy, breast cancer is the most common cancer form among women, accounting for over 20% of the cancer cases and about 15% of the mortality (Jemal et al., 2011). Dysregulation of the composition of the extracellular matrix (ECM) is associated with cancer, by facilitating cell growth, survival and invasion. Among various ECM glycosaminoglycans, hyaluronan (HA) has a remarkable structural importance but also a role in regulating cellular processes through a binding with membrane receptors and activation of signalling pathways. The role of HA in tumour cells’ functions depends on its molar mass which is regulated by the enzymes that synthesize HA, i.e. hyaluronan synthases (HAS), and hyaluronidases (HYALs). Alterations of these metabolic enzymes are correlated with breast cancer progression.
In this thesis, we aimed to explore the role of crosstalk between tumour cells and stroma, focusing our attention to the HA regulation. Specifically, we studied the mechanism by which proteins secreted by breast tumour cells alter HA metabolizing enzymes and its synthesis in the stromal cells.
Recently, in our laboratory we discovered a new protein in the conditioned medium (CM) of a breast tumour cell line, called “Uncharacterized protein of c10orf118” or “Q7z3e2”. For simplicity, this protein is called “Q7”. Further studies on the two well-known breast cancer cell lines MCF-7 (low invasive cells) and MDA-MB231 (high invasive cells) demonstrated a higher expression and secretion of Q7 in tumour cells than in normal cells. Information obtained from bioinformatics databanks (the Ensemble website) showed that the gene for Q7 is located on human chromosome 10 in the region q25.3. The gene is composed of 18 exons and there are six splicing variants, but only four of them code for proteins. The secreted isoform found in the CM of breast cancer cell lines is the full-length isoform that consists of 898 aminoacids and has a molecular weight of 104 kDa.
In the literature and in our data, it was shown that co-culture of breast cancer cells with fibroblasts results to an induction of HAS2 in fibroblasts and an increase of the secreted HA. Among the three HASes, HAS2 isoform was the most expressed and induced by breast tumour cells CM in fibroblasts, whereas HAS1 was not detected. When fibroblasts were treated with CM from MCF-7 cells, in the absence of Q7, the relative expression of HAS2 was significantly decreased. This last data was further confirmed when fibroblasts were treated with a recombinant protein of Q7 and a HAS2 induction and HA increase were observed.
To sum up, the data of this thesis demonstrate that the novel protein Q7 may play a key role in the increment of pericellular HA and in the breast tumour progression
Perfusione meccanica ipotermica nel trapianto di rene da donatore marginale: follow up a breve e lungo termine.
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Tempo razionale e tempo irrazionale nella generazione dei flussi di coscienza”. Un’indagine tematica sulle funzionalità della memoria come elemento costitutivo dell’identità psichica
No full textL’analisi del concetto di tempo ha prodotto un enorme numero di riflessioni e di teorie, delineando posizioni problematiche. Un grande problema, forse di fatto insolubile, è legato al fatto che il tempo è un oggetto di considerazione e, contemporaneamente, va a coincidere con lo stesso soggetto considerante.
Il tempo presente, poi, ha da sempre, diverse facce. Talvolta nette e precise; talaltra sfumate e soffuse. Facce diverse, eppure tanto interconnesse che quasi trenta secoli di indagine filosofica e quattro di indagine scientifica non sono riusciti a risolverle.
Il tempo si può esperire attraverso un continuum misurabile ad una sola dimensione ma, contemporaneamente, il tempo risulta composto da un’estensione passata e di un’estensione futura, il cui punto di confine è, di per sé, privo di estensione. Eppure è l’unico che riusciamo a percepire poiché è il tempo del soggetto considerante.
Ancora una volta, quindi, il tempo rimane avvolto da un mistero ultimo e appare, almeno nella sua totalità, incomprensibile.
Qualcosa, però, sappiamo con certezza: il tempo non è un accidente della vita bensì ne è l’essenza, l’elemento fondante, impalpabile, inspiegabile, incomprensibile, che tutto impregna e pervade.
Dunque, se il tempo non è soltanto un fattore esterno dell’esistenza umana, allora la memoria, generata dal suo fluire, è qualcosa di più della semplice reminiscenza.
Nel percorso tematico articolato in questa tesi abbiamo cercato di esaminare come il tempo, nelle sue due dimensioni, quella razionale e quella irrazionale, sia proprio un elemento costitutivo dell’esperienza umana e come quest’ultima contribuisca alla formazione della coscienza della persona e della sua identità psichica, formata da un conscio e da un inconscio. Non è, infatti, paradossale affermare che soltanto gli esseri coscienti, intesi come coloro che hanno sviluppato una coscienza del senso, possono possedere anche un inconscio.
Le questioni urgenti dello sviluppo della scienza e il diffondersi della tecnocrazia che, da ormai quasi un secolo, stanno imperversando nelle nostre terre occidentali, hanno fatto sì che problematiche come il tempo, la vita, lo spirito, il divino e le tematiche metafisiche più in generale, venissero accantonate per dare spazio ad argomenti più concreti e a riflessioni di stampo epistemologico. In questo modo, però, l’uomo è rimasto, nei confronti del proprio Essere, sprovvisto di risposte soddisfacenti che ha rimpiazzato con l’abuso di strumenti tecnologici attraverso i quali ha sperato di appagare corpo e anima.
Purtroppo, invece, le tematiche metafisiche trattano delle questioni supreme dell’uomo, soprattutto quando si trova di fronte alla sfida del significato stesso dell’essere umano, reale e vivo, e ancora, quando si trova di fronte al problema dell’esistere e della sopravvivenza.
Gli sviluppi tecnologici introdotti dall’avvento dei computer e della realtà virtuale hanno aperto, in questi ultimi decenni, una feconda stagione di ricerche, dando origine a nuove ipotesi che hanno coinvolto la filosofia del linguaggio e le psicologie cognitiviste con l’intento di rendere più comprensibili alcuni fenomeni dell’attività percettiva e noetica dell’uomo. Da queste nuove ipotesi e da questi nuovi strumenti tecnologici si sono, inoltre, generate alcune terre di confine ancora da esplorare.
Una di queste è il territorio delle neuroscienze che sconfina nella medicina da un lato e nella psicologia dall’altro, utilizzando a piene mani il potenziale tecnologico offerto dalle nuove scoperte informatiche e scientifiche.
La relazione tra spirito e materia trova, infatti, oggi come nell’antichità, ancora diversi nodi da sciogliere e, nonostante l’attuale proliferazione di modelli epistemologici, la filosofia contemporanea fatica a individuare i confini del proprio indagare.
La riflessione di Bergson, che abbiamo utilizzato come palinsesto del nostro impianto teoretico, si ripresenta oggi più attuale che mai e potrebbe fornirci un modello di pensiero che possa essere utilizzato per indagare filosoficamente questa terra di confine chiamata neuroscienza poiché Bergson sviluppa una filosofia della durata interiore e della percezione pura muovendo da un interesse specifico per i fondamenti della fisica e della medicina; approderà all’idea straordinaria della memoria come ambito privilegiato della coscienza del sé che trova il suo fondamento nella concezione della natura dinamica dell’io e della realtà stessa.
La memoria, infatti, assume, in questa prospettiva, il valore di coscienza indivisa della propria durata, del proprio mutare e anche coscienza immediata del divenire delle cose. Senza memoria, dunque, non ci potrebbe essere nemmeno intuizione della durata, cioè dell’esistenza e dello scorrere della vita psichica.
L’uomo, dunque, è l’insieme delle emozioni, delle sensazioni, delle esperienze che ha vissuto, amalgamate sapientemente dalla memoria in modo che, nella coscienza, l’Io non possa ravvisare una distinzione del sé dal proprio vissuto.
Non vi sono dubbi, allora, sul fatto che solo grazie alla memoria e al ricordo la coscienza è in grado di organizzare le esperienze per farne narrazione; per esse, in qualche modo, creiamo una dimensione aggiuntiva che noi chiamiamo “tempo” ma che non ha durata in quanto si tratta di un semplice allineamento logico-deduttivo allineato con lo spazio (ciò che è accaduto prima, ciò che è accaduto dopo). Semplice giustapposizione.
Riassumendo, quindi, il tempo della coscienza del sé, avvero la durata reale, è molteplicità qualitativa di stati irrazionali che si compenetrano; successione senza giustapposizione; ma poiché dove c’è coscienza di qualcosa c’è anche memoria (quindi il sorgere di un prima e di un dopo) la durata reale è l’insieme dell’intensità dell’esperienza immediata percepita dalla coscienza che penetra nel flusso razionale del tempo.
Da qui è facilmente comprensibile come sia la dimensione irrazionale che la dimensione razionale del tempo siano indispensabili affinché l’uomo possa generare un flusso coscienziale che gli permetta di distinguere se stesso dall’alterità e lo renda creatura unica e irripetibile.
Quanto detto sino a ora ci permette di formulare un’ipotesi circa la struttura della coscienza. Il tempo esiste solo nel momento in cui percepiamo la nostra durata interiore; diversamente, come nel paziente psicotico o nel nevrotico, in cui il rapporto tra Io e coscienza è alterato dalla malattia, il tempo assume valori e misure differenti; non necessariamente più o meno attinenti al reale poiché per il paziente psicotico, o per il nevrotico, il reale corrisponde a ciò che percepisce il suo Io ed è, semplicemente, di qualità differente.
Lo stesso può essere osservato per la formazione del ricordo. Se non può esservi durata senza memoria, allora il problema della formazione del ricordo deve essere analizzato con la massima profondità possibile perché solo così si potrà tentare di formulare una risposta alla questione della realtà e della natura del tempo al di fuori della coscienza.
Da qui deriva che la memoria non può essere ridotta alla sola conservazione automatica del passato. Essa non può che derivare da una trasformazione qualitativa sia della formazione del ricordo che dell’evocazione del ricordo stesso. Insomma, perché ci sia coscienza, dunque memoria, è necessario che il dato percettivo sia sottoposto a un cambiamento strutturale e questa necessaria trasformazione si realizza proprio attraverso la durata, ovvero il tempo della coscienza.
Se la memoria è parzialmente conservazione del passato, questo passato conservato può essere reso presente solo grazie alla tensione del tempo della coscienza ed è proprio la coscienza, dunque, a illuminare, in ogni momento, quell’immediata parte di passato che, proteso sul futuro, lavora per realizzarlo e trasformare in ente ciò che è ancora niente.
The issues about development of science and the spread of technocracy that, for almost a century, are raging in our western lands, have allowed that issues such as the time, life, spirit or, more generally, the metaphysical topics, they were set aside to give way to more concrete topics and epistemological reflections.
In this way, however, the man was, in respect of its being, without a satisfactory response it has replaced with the abuse of technological tools by which he hoped to satisfy body and soul.
Unfortunately, however, the metaphysical issues concern the supreme question about man, especially when he is faced with the challenge of the very meaning of being human, real and alive, and yet, when he is faced with the problem of existence and survival.
In reasoning we sought, we examine how time in its two dimensions, is a constitutive element of human experience and how it contribute to the formation of the conscience of the person and of his psychic identity, composed of a conscious and an unconscious
Technological developments introduced by the coming of computers and virtual reality have opened in recent years, a rich season of research, giving rise to new theories; from these new hypotheses and from these new technological tools have also generated some border lands yet to be explored. One of these is the area of neuroscience.
The Bersgson’s reflection, which we used as a palimpsest of our theoretical foundation, persists today and could provide a model thought that can be used to investigate philosophically this borderland called neuroscience because Bergson develops a philosophy of inner life and pure perception moving from a focus on the fundamentals of physics and medicin
Confronto tra MTWA e MIBG nella stratificazione del rischio di morte cardiaca improvvisa: studio pilota.
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On the quality of Web Services.
No full textWeb Services (WSs) are gaining increasing attention as programming components and so is their quality. WSs offer many benefits, like assured interoperability, and reusability. Conversely, they introduce a number of challenges as far as their quality is concerned, seen from the perspectives of two different stakeholders: (1) the developer/provider of WSs and (2) the consumer of WSs. Developers are usually concerned about the correctness of the WS's functionality which can be assessed by functional testing. Consumers of WSs are usually careful about the reliability of WSs they are depending on (in addition to other qualities). They need to know whether the WSs are available (i.e., up and running), accessible (i.e., they actually accept requests) while available and whether they successfully deliver responses for the incoming requests. Availability, Accessibility, and Successability of WSs are directly related to WS reliability. Assessing these three factors via testing is usually only feasible at late stages of the development life-cycle. If they can be predicted early during the development, they can provide valuable information that may positively influence the engineering of WSs with regards to their quality.
In this thesis we focus on assessing the quality of WSs via testing and via prediction. Testing of WSs is addressed by an extensive systematic literature review that focuses on a special type of WSs, the semantic WSs. The main objective of the review is to capture the current state of the art of functional testing of semantic WSs and to identify possible approaches for deriving functional test cases from their requirement specifications. The review follows a predefined procedure that involves automatically searching 5 well-known digital libraries. After applying the selection criteria to the search results, a total of 34 studies were identified as relevant. Required information was extracted from the studies, synthesized and summarized.
The results of the systematic literature review showed that it is possible to derive test cases from requirement specifications of semantic WSs based on the different testing approaches identified in the primary studies. In more than half of the identified approaches, test cases are derived from transformed specification models. Petri Nets (and its derivatives) is the mostly used transformation. To derive test cases, different techniques are applied to the specification models. Model checking is largely used for this purpose.
Prediction of Availability, Accessibility, and Successability is addressed by a correlational study in which we focused on identifying possible relations between the quality attributes Availability, Accessibility, and Successability and other internal quality measures (e.g., cyclomatic complexity) that may allow building statistically significant predictive models for the three attributes. A total of 34 students interacted freely with 20 pre-selected WSs while internal and external quality measures are collected using a data collection framework designed and implemented specially for this purpose. The collected data are then analyzed using different statistical approaches.
The correlational study conducted confirmed that it is possible to build statistically significant predictive models for Accessibility and Successability. A very large number of significant models was built using two different approaches, namely the binary logistic regression and the ordinal logistic regression. Many significant predictive models were selected out of the identified models based on special criteria that take into consideration the predictive power and the stability of the models. The selected models are validated using the bootstrap validation technique. The result of validation showed that only two models out of the selected models are well calibrated and expected to maintain their predictive power when applied to a future dataset. These two models are for predicting Accessibility based on the number of weighted methods (WM) and the number of lines of code (LOC) respectively.
The approach and the findings presented in this work for building accurate predictive models for the WSs qualities Availability, Accessibility, and Successability may offer researchers and practitioners an opportunity to examine and build similar predictive models for other WSs qualities, thus allowing for early prediction of the targeted qualities and hence early adjustments during the development to satisfy any requirements imposed on the WSs with regards to the predicted qualities. Early prediction of WSs qualities may help leverage trust on the WSs and reduces development costs, hence increases their adoption
The Musso fault and its role in the evolution of the northern lake Como basement.
No full textThe structural analysis of the MML and the surrounding basement lead to observe that:
1) The MML is completely bounded by main fragile fault planes and ductile structures.
2) The main foliation of the MML is only partly aligned to the regional E-W trending S2 foliation.
3) The MML has different N-S trending mylonitic foliation and fracture cleavage compared to S/SW dipping mylonitic foliation of the southern basement.
4) The apparent absence of garnet in the MML metabasites suggest a different metamorphic imprint in respect to the surrounding basements.
5) There are not sufficient petrographic data to determine the belonging of the MML to the different structural units recognized in the Southern Alpine basement.
6) The MML reached the Permo-Triassic thermal peak similar to that of surrounding basement.
Within the MML, the marble-metabasite contact has locally characteristics that we interpreted as not correlated to the metamorphic evolution but resembling relicts of primary magmatic intrusion: i) lobes, ii) compositional layering parallel to the contact of the lobes, iii) diffuse sulphide mineralization at the metabasite-marble contact, iv) small interfingering of metabasite protruding within the marble resembling a fluidification of the hostrock, v) crosscutting of the dykes, vi) parallel tabular structures with geometry not related to any metamorphic event thus resembling dykes, vii) contact band characterized by mixing of phases suggesting a widespread mixing at the protoliths interface.
The seven described structures, all found in the MML, resemble those of a basalt intrusion within a carbonatic sediment only partially lithified.
Major, trace and REE elements of Musso and Lugano-Val Grande Fault Zone (LGFZ) metabasites, analyzed in this study, are compared to other metabasite and volcanics of the Southern Alps available in the literature: I) metabasites with and without cummingtonite from the Piona Peninsula (DOZ), II) metabasites from the Strona Ceneri Border Zone (SCBZ) and III) Triassic basaltic volcanics of the central Southern Alps.
The LGFZ sample have very similar geochemical characteristics to SCBZ that allow to suppose a common origin. Musso samples show an in-between composition: they have similar Ba, Na, Al content to the SCBZ, LGFZ, and Triassic volcanics but have TiO2, Zr, Nb, MgO and SiO2 content similar to Anisian (a group belonging to the Triassic set) and part of the DOZ. This could be due to a partial metamorphic imprint with elements depletion, or a different volcano-tectonic origin, more similar to that of the Anisian basalts. Genetic diagrams, from literature, confirm the division between the DOZ and the SCBZ. SCBZ and LVGZ appear as a compact group with a MORB to tholeiitic composition. The Musso samples belong to intraplate products with alkali-basalt to tholeiitic composition.
These data are only partially sufficient to suppose a particular role of the Musso marble lenses and the included metabasites but definitely testify the existence of this tectonic structure since at least Variscan age (Devonian-Early Carboniferous).
In Chapter 3, the ductile and brittle structures mapped along the Musso Fault Zone (MFZ) are described and a hypothesis for the Musso fault evolution is presented, touching the following main stages:
1) Marble lenses (Musso marble) are boudinaged along the MFZ and represent the oldest rocks characterizing it. Their age is still not determined, but the included metabasites have unique geochemical characteristics that do not allow to attribute them nor to DOZ nor the Strona Ceneri Border Zone amphibolite suites. We speculate a Devonian perhaps to Early Carboniferous age for the marble and the included metabasites.
2) Geochronological and thermal data from literature shows that the Northern Lake Como region experienced a Triassic thermal peak and development of intra-basement shear zones, thinning the Adriatic crust. In this context the oldest structures directly and incontrovertibly connected to the MFZ are the Fe-carbonate veins, of Early Triassic age, which are preserved also boudinaged within the Musso mylonites. The same can be said also for the LGFZ, as demonstrated by extensive siderite mineralization presence in the Gaeta mine and Val Cavargna.
3) Fe-mineralized veins are found in similar extensional context in all the Southern Alps, along faults bordering Permo-Triassic continental basins. Therefore it is possible that also the MFZ was bordering a small basin to the N, nonetheless justifying the presence of the sedimentary Monte Pozzuolo and Sasso Pelo. In the Lake Como area continental extension started in the Norian and continued to Liassic.
4) The mylonites of the MFZ possibly developed after the Early Triassic thermal peak when temperature dropped to around 250-350°C allowing crystallization of quartz-albite-chlorite-sericite associations, before the emplacement of the 220Ma old Piona’s pegmatites which do not show mylonitization even near the MFZ.
5) From the Liassic to the onset of the Alpine compressive stage there is a long inactivity time span, with no records for the MFZ.
6) Alpine N-S contraction brought into a steep south dipping position the Paleozoic to Mesozoic rocks and lineaments and caused upper and middle crust to detach from their substratum along the MFZ. This contraction was responsible of the ductile-brittle deformation observed along the MFZ with development of widespread and abundant pseudotachylytes. Similar structures dated along the Orobic and Porcile thrusts yielded two sets of ages: an older Late Cretaceous and a younger Eocene ages.
7) Widespread distensive cataclastic bands along the Musso and contiguous faults, possibly indicating a distensive to transpressive stage, by correlation with nearby data of Val Morobbia, may belong to Oligocene.
8) Finally, right strike-slip dextral brittle deformation took place, visible along the largest fault planes, most probably driven by the Insubric Line
Synthesis, characterisation and motophysical properties of d10-metal luminescent compounds.
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Reaction-diffusion models on a network: stochastic and deterministic pattern formation.
No full textThis thesis deals with the study of pattern formation on complex networks, a topic of paramount importance in different fields of broad applied and fundamental interest. Starting from a prototypical reaction-diffusion model, two main directions of investigation have been explored: on the one side, we have examined the system in its deterministic limit. Partial differential equations hence govern the evolution of the concentrations of the interacting species. In the second part of the thesis, we have conversely adopted a stochastic viewpoint to the scrutinized problem. Both in the deterministic and in the stochastic settings, the species are assumed to populate a complex graph, which provide the spatial backbone to the inspected model. Diffusion is allowed between neighbouring nodes, as designated by the associated adjacency matrix.
According to the deterministic formulation, a small perturbation of a homogeneous fixed point can spontaneously amplify in a reaction-diffusion system, as follow a symmetry breaking instability and eventually yield asymptotically stable non homogeneous patterns. These are the Turing patterns. Travelling waves can also develop as follows an analogous dynamical instability. In this Thesis we have considered the peculiar setting where the spatial support is a directed network. Due to the structure of the network Laplacian, the dispersion relation has both real and imaginary parts, at variance with the conventional case for a symmetric network. The homogeneous fixed point of the system can turn unstable because of the topology of the hosting network. This observation motivates the introduction of a new class of instabilities, termed topology driven, which cannot be induced on undirected graphs. A linear stability calculation enables one to analytically trace the boundaries of the instabilities in the relevant parameters plane. Numerical simulations show that the instability can lead to travelling waves, or quasi-stationary patterns, depending on the characteristics of the underlying graph. Another scenario where topology matters is that of multi-layered networks, also known as multiplex networks. We have shown in this Thesis that the emergence of self-organized patterns on a multiplex can be instigated by a constructive interference between layers. It can be in fact proven that patterns can emerge for a reaction-diffusion system defined on a multiplex, also when the Turing-like instability is prevented to occur on each single layer taken separately. In other cases inter-layer diffusion can have a destructive influence on the process of pattern formation, as we will discuss in details in this Thesis work.
Beyond the deterministic scenario, single individual effects can also impact the process of pattern formation. Stochastic fluctuations, originating from finite size populations, can in fact significantly modify the mean-field predictions and drive the emergence of regular macroscopic patterns, in time and space, outside the region of deterministic instability. In the second part of the Thesis we have studied the dynamics of stochastic reaction-diffusion models defined on a network. A formal approach to the problem has been developed which makes use of the Linear Noise Approximation (LNA) scheme. Simulations based on the Gillespie algorithm were performed to test the analytical results and analyzed via a generalized Fourier transform which is defined using the eigenvectors of the discrete graph Laplacian. Travelling waves as well as stationary patterns reminiscent of the Turing instability are shown to develop as mediated by the discreteness of the stochastic medium. As a final point we considered the case of a general stochastic reaction-diffusion system, where the activator is solely allowed to diffuse. Working under the LNA, we proved that stochastic Turing like pattern can develop, an observation which marks a striking difference with the conventional, customarily adopted, deterministic scenario
Farmacoterapia e qualità della vita nella sindrome di Gilles de la Tourette
No full textBACKGROUND: Few studies have used standardized and specific instruments to assess the Health-Related Quality of Life (HR-QoL) in Tourette Syndrome (TS). Moreover, there are no studies focusing on pharmacotherapy and HR-QoL.
AIMS: We compared the clinical characteristics and the HR-QoL in youth and adult TS patients with and without pharmacological treatment.
METHODS: We recruited 112 TS patients (94 males; age range 7-64 years). All patients were evaluated by a trained neuropsychiatrist in TS and completed the Gilles de la Tourette Syndrome-Quality of Life scale (GTS-QoL). Clinical features of TS and severity of tics were assessed by specific clinical rating such as the Yale Global Tic Severity Scale (YGTSS) and Tourette’s Syndrome Diagnostic Confidence Index (TSDCI).
Results were compared between patients with and without pharmacological treatment. We also divided the sample in two groups ( 18 years), and the same comparison was performed both between groups (young patients vs adult patients) and within each group.
RESULTS: Forty-four TS patients (39,3%) were on pharmacotherapy (23=monotheapy; 16=dualtherapy, 5=politherapy). Of note, 86 patients (76.8%) fulfilled diagnostic criteria for at leas one comorbid condition. No significant differences were found in HR-QOL between youth and adult TS patients with pharmacotherapy. However, young patients on pharmacotherapy showed higher mean scores on GTS-QoL Obsessive Scale (p=0,009) than peer without treatment.
As expected, comparing the mean scores of GTS-QoL with YGTSS and TS-DCI scores we found a significant correlation between HR-QoL and tic severity ratings.
Age-related analysis showed that in young patients the presence of OCS correlated with higher GTS-QoL Obsessive (p=0,043), whereas adults reported higher scores on the majority of GTS-QoL domains in correlation with the presence of OCD, ADHD and sleep problems.
DISCUSSION: The treatment for patients with TS is based on a broad diagnostic process. The use of drugs for treatment of TS, especially in children, must be done only when tic interfere with daily life, cause subjective discomfort and cause sustained social/emotional problems. Indeed, our results showed that adult TS patients for whom it was necessary a pharmacotherapy are those who had worse HR-QOL. Moreover, patients with pharmachoterapy showed higher severity of TS’ symptom
STARR vs internal delorme for obstructed defecation: a prospective randomized trial.
No full textTransanal rectal resection with two circular staplers (STARR) and transanal mucosectomy (endorectal proctopexy or Internal Delorme) are two effective surgical approaches to severe obstructed defecation syndrome (ODS)associated to rectocele and rectal intussusception. Thirteen cinsecutive patients with ODS (average age 56.6 years) underwent surgery at Luigi Sacco University Hospital of Milan between October 2009 and February 2011. After routinely preoperative diagnostic work-up, patients were randomized to STARR (n=7) or Delorme procedure (n=6). All patients were submitted to three questionnaires: SF-36, ODS score and Wexner Continence Score before and after surgery (3 months, 1 and 4 years). All data and post operative complaints were recorded and collected by an independent investigator. All variables related to ODS symptoms have improved with both surgical techniques at 3 months, 1 year and 4 years (p<0,05). No major complication occurred. The overall short-term minor complications rate was 3/7 in the STARR group and 3/6 in the Internal Delorme group. Our study confirms the safety and the efficacy of the surgical approach with STARR or with Internal Delorme procedure in selected patients with ODS. Global health and psychological well being at 3 months, 1 year and 4 years after surgery are similar for both techniques